From point by point to single shot: evolution of visually guided pulmonary vein isolation using the third‐generation laser balloon catheter

BACKGROUND: The third-generation laser balloon (LB3) became available recently. We aimed to describe the impact on procedural efficacy and safety of LB3 compared to the second generation LB2 for pulmonary vein (PV) isolation (PVI) in patients with atrial fibrillation (AF). METHODS: Consecutive patients treated with the LB3 for symptomatic AF were enrolled. As a control group the previous consecutive patients treated with the LB2 were analyzed. Acute procedural data and complications between two groups were retrospectively analyzed. RESULTS: A total of 84 patients with LB3 (317 PVs, 75.9% Paroxysmal AF) and the previous 100 patients (387 PVs, 63.0 % Paroxysmal AF) with LB2 who underwent PVI were enrolled in this study. LB3 enabled significantly shorter procedural time (LB3: 60.6 +/- 22.0 min vs LB2: 100.9 +/- 21.5 min, P < 0.0001) and fluoroscopic time (LB3: 7.2 +/- 3.5 min vs LB2: 8.6 +/- 3.2 min, P = 0.0046). Complete PV isolation after initial circular ablation was achieved in 75.0% with LB3 and 77.7% with LB2 (P = 0.725). Optimal PV occlusion grade was the only independent predictor of successful PVI after initial circular LB3 ablation (OR: 0.190; 95% CI: 0.062 - 0.572; P = 0.0035). Balloon pinholes were recorded more often in LB3 group (LB3: 19.1% vs LB2: 7%, P = 0.0236) CONCLUSION: LB3 confirmed a high rate of visually guided PVI, foreshortening procedure duration and fluoroscopy use. However, the use of LB3 was associated with a considerable rate of pinhole balloon ruptures. This article is protected by copyright. All rights reserved.